<html>
<head>
<title>Add</title>

<link rel="stylesheet" type="text/css" href="/css/form.css" /> 
</head>
<body>

  <form action="/code/css/forms/" method="post">

    <p><strong>Bold</strong> fields are required.</p>

    <fieldset><legend>Personal Information</legend>

      <div class="notes">

        <h4>Personal Information</h4>

        <p class="last">Please enter your name and address as they are listed for your debit card, credit card, or bank account.</p>

       </div>

      <div class="required">

        

        <label for="first_name">First Name:</label>

        <input type="text" name="first_name" id="first_name" class="inputText" size="10" maxlength="100" value="" />

      </div>

      <div class="required">

        

        <label for="last_name">Last Name:</label>

        <input type="text" name="last_name" id="last_name" class="inputText" size="10" maxlength="100" value="" />

      </div>

      <div class="optional">

        

        <label for="address_1">Address:</label>

        <input type="text" name="address_1" id="address_1" class="inputText" size="10" maxlength="100" value="" />

        <input type="text" name="address_2" id="address_2" class="inputText" size="10" maxlength="100" value="" />

      </div>
      
<div class="required">

        

        <label for="note_narrow">Your Message:</label>

        <textarea name="note_narrow" id="note_narrow" class="inputTextarea" rows="10" cols="21"></textarea>

        <small>Must be 250 characters or less.</small>

      </div>
       <div class="required wide">

        <label for="note_wide">Your Message:</label>

        <textarea name="note_wide" id="note_wide" class="inputTextarea" rows="10" cols="21"></textarea>

        <small>We'd love to get your feedback on any of the products or services we offer or on your experience with us.</small>

      </div>
      </fieldset>
</form>

</body>
</html>